Covered California

The California Health Exchange

Get covered. Avoid Penalties. Qualify for a Government Subsidy.

What is Covered California?

The Covered California Health Exchange is the government agency offering subsidized Obamacare plans for this state. The California Health Exchange was created to assist citizens and legal residents with applying for marketplace coverage in order to comply with the Affordable Care Act (“ACA”). When the law was passed in 2010, each of the 50 states had to decide to either create a state-run health insurance exchange or offer enrollment through a federally-operated exchange. This state chose to create their own exchange and called it “Covered California”.

What does the California Health Exchange do?

The Exchange helps Californians comply with the Obamacare mandate. It helps individuals and families obtain health coverage that includes the minimum essential benefits required by the law. Certain carriers are certified to offer subsidized Obama Care Plans and Prices plans and dental plans through the Exchange. These Covered California plans can sell insurance on or off the Exchange. But for qualified consumers, rates can be better if the medical plan is purchased through the marketplace.

For people with a household income that is below 400% of the Federal Poverty Level (“FPL”), Covered Ca may qualify them to receive financial assistance, also called a “Subsidy”, which reduces their premium. And if income is between 138% and 250% of the FPL, the State Exchange may also qualify individuals for extra discounts that reduce their cost for medical services. These extra discounts are referred to as “Cost Sharing Reductions”. To be eligible for a subsidy and potentially for cost sharing reductions, you must fall within Covered California income limits and not be offered affordable, full coverage healthcare through an employer, Medicare, etc. Enrollments need to be submitted through the State Marketplace, a Certified Insurance Agent, or a Certified Enrollment Counselor.

The Obama Care Mandate: What is required?

The “mandate” refers to the federal law that requires all American citizens and legal residents to have qualified medical insurance. This medical coverage may be acquired off-exchange or through Covered California. The mandate is also known as the Affordable Care Act, or Obama Care. For more information, visit Obama Care California. Under the mandate, Americans and legal residents are required to do one of the following:

Be enrolled on a qualified health plan. You can be uninsured for part of the calendar year and not be subject to a penalty so long as you are uninsured for less than three consecutive months.

What is a qualified health plan?

For Californians to be in compliance with the mandate, they’ll need to be enrolled on a qualified health plan, plan that meets the government’s requirements for minimum essential coverage. The main coverage requirement is that the insurance must cover the 10 minimum essential benefits, such as preventive services, Prescription Drug Coverage, and maternity and newborn care. A medical plan can still be a qualified health plan without the minimum essential benefits if the plan is a grandfathered plan, which is a medical plan that was in force before March 23, 2010 when the mandate was passed and which has not undergone major changes. Qualified health plans may be acquired through Covered California, Medi-Cal, Medicare, group insurance, a plan through the military, or off-exchange directly through the carrier.

How do I enroll in a Covered California Marketplace Health Plan?

Update: Open-Enrollment begins November 1st, 2016. However, individuals and families with a qualifying life event may enroll now.

California State health insurance applications are accepted once a year at open enrollment. The next open enrollment period is November 1, 2016 through January 31, 2017. During this time frame, you may apply for a new plan or switch Covered California plans. You do not have to have a special reason to apply. If you miss enrolling during this period, you will not be able to apply for Obamacare coverage until the next open enrollment. Exceptions apply.

You may apply for Covered California health insurance outside of open enrollment if any of the following apply to you:

You have a qualifying life event, such as an involuntary loss of coverage, relocation, a change in marital status, or the birth of a child. To apply for a special enrollment, you must submit an application within 60 days of the event date.

You are part of a Federally-recognized American Indian tribe or are an Alaska Native. The open enrollment period does not apply to you. You may apply or switch Covered California plans once a month, if desired.

After you submit an application, you are not officially enrolled until you pay the first month’s premium. It must be remitted by the due date or your application will not be processed.

As part of the application process, the State Insurance Exchange will electronically verify your identity, citizenship or *immigration status, and your income. Records of other government agencies will be used. If Covered California is unable to verify your information, your application may be processed in one of the following ways:

Your application may be marked as “conditionally eligible”. You will be covered for the next 90 days but you will be requested to provide supporting documents in order for the insurance or the subsidy to continue.

Your application may be processed for Medi-Cal insurance instead of the health plan you requested through Covered California. Usually, this action is taken if your IRS income records from the prior year were lower than the income listed on your application.

*Note: Verification of immigration status will not be used for the purpose of enforcing immigration laws.

Group Medical Insurance Plans on the California Health Exchange

If you are a business owner, you may be able to obtain group health insurance California coverage. This would allow you to offer coverage from multiple carriers and still have only one bill. Prices will be the same on all group health Covered California plans whether they are purchased on the State Exchange or not.